ABSTRACT Excess adiposity and obesity are the root cause of at least 27 diseases that cause considerable lifelong morbidity and, in many scenarios, eventual cardiovascular mortality. The human body has the ability to increase the number and size of its adipocytes by approximately 10-fold over the course of a lifetime. As fat mass increases, its blood supply, supporting cells, tissue structure, and local and systemic hormonal control also increase. This results in excess adiposity, leading to progressive obesity and the resistance to weight-loss attempts. There have been numerous trials of food diets combined with exercise that, in general, have a 50% dropout rate at 1 year and lead to very modest (∼ 5%) reductions in body weight. Thus, many with obesity require interventions beyond casual diet and exercise advice. Meal replacement diets and bariatric surgery offer considerably greater degrees of weight loss, but both can be plagued by weight regain. Because the ability to control food urges has been shown to be a key psychological factor for success, medicinal approaches that work in this domain are attractive adjuncts to diet, exercise, and weight-loss surgery. This article reviews the emerging role of medical therapy in the treatment of excess adiposity with the goal of reducing comorbidities and possibly improving cardiovascular survival.

[Show abstract][Hide abstract]ABSTRACT: Almost 20 years ago, the protein encoded by the ob locus in mice was identified as an adipocyte-secreted hormone, now termed leptin, which functions as a peripheral signal to communicate the organism's energy reserve-and thereby protects against starvation due to insufficient caloric resources. Additional peripheral factors have since been identified that coordinate interorgan crosstalk to manage energy resources. The heart is included in this network through its regulated release of natriuretic peptides A and B-cardiac hormones originally identified as important in blood pressure control. Emerging evidence that natriuretic peptide receptors are expressed in adipose tissue, and that circulating levels of these peptides are decreased in animals and humans with obesity, could imply that natriuretic peptides are also involved in the regulation of energy metabolism. The natriuretic peptides stimulate triglyceride lipolysis in adipocytes, a process also regulated by the sympathetic nervous system. In addition, these two pathways promote uncoupling of mitochondrial respiration and thermogenesis in brown adipocytes. This Review focuses on the roles of the natriuretic peptides and the sympathetic nervous system in regulating adipocyte metabolism. The potential for manipulating the natriuretic peptide pathway to increase energy expenditure in obesity and manage the complications of cardiometabolic disease is also discussed.

[Show abstract][Hide abstract]ABSTRACT: To examine whether weight loss strategies are associated with consumption of sugar-sweetened beverages (SSBs), snacks or food values.
Cross-sectional analysis of 24-h dietary recall data obtained from the National Health and Nutrition Examination Survey 2007-2010 (N=9440).
Adults trying to lose weight consumed roughly 2000 total calories, 250 calories from SSBs, 225 calories from salty snacks, and 350 calories from sweet snacks. Adults not trying to lose weight consumed roughly 2300 total calories, 300 calories from SSBs, 250 calories from salty snacks, and 380 calories from sweet snacks. While overweight and obese adults trying to lose weight consumed fewer calories than those who were not, heavier adults trying to lose weight using dietary strategies or a combination of diet and physical activity consumed more calories than healthy weight adults using that same weight loss strategy (p<0.05). Price (>70%) and nutrition (>50%) were most when making food choices (p<0.05) for all groups.
Consumption of discretionary calories is high regardless of body weight or weight loss intention.
Promoting reduced SSB and snack consumption in the clinical setting may be important for weight loss, particularly among heavier individuals. Clinicians should consider values related to food purchasing to identify concrete behavioral targets.

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